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Please print or type.(Form designed for use on elite(12-pitch)typewriter.) Form Approved.OMB No.2050-0039 UNIFORM HAZARDOUS 1.Generator ID Number 2.Page 1 of 3.Emergency Response Phone 4.Manifest Tracking Number WASTE MANIFEST CAL 0 0 0 0 9 5 9 9 6 1 (800)424-9300 015481715 J J K 5.Generators Name and Mailing Address Generators Site Address(if different than mailing address) City of Manteca City of Manteca 1001 West Center Street,Manteca,CA 95337 1077 Milo Candini Drive,Manteca,CA 95337 Generators Phone(209)456-8415 Attn:Greg Showerman 6.Transporter 1 Company Name U.S.EP ID Number "tcv �6 7.Transporter 2 Company Name U.S.EPA ID Num er 8.Designated Facility Name and Sm Address U.S.EPA ID Number Buthanwillow Landfill 2500 West Lokem Road,Buttonwillow,CA 93206 Facility's Phone:(661)762 -6200 CAD 9 8 0 6 7 5 2 7 6 9a. 9b.US.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit 13.Waste Codes HM and Packing Group(it any)) No. Type Quantity WI.NaI. K 1 61 1 NON-RCRA Hazardous Waste,Solids,(Lead) 0 0 1 D T 18 y M 2 c� I 3. I 4. 14.Special Handling Instructions and Addition it Information Sail: 95-100% Clean Harbors Profile Number: C H 13 12 3 0 7 B Vegetation:0-5% Wear appropriate Personal Protective Equipment as necessary 15. GENERATOR'SIOFFEROR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described above by the proper shipping name,and are classred,packaged, marked and Iahelediplacarded,and are in all respects in proper condition for transport according to apWicaMe international and national governmental regulations.if export shipment and I am the Primary Exporter,I certify that the contents of this consignment ocri orn to the tarots of the attached EPAAcknowledgment of Consent. certify that the waste minimization statement Identified in 40 CFR 262.27(a)(8I am a targe quantity generator)or(b)(8I am a small quantik generator)is true. GeneratoeslOBemrs PnntedlFyped NameSignature Month Day Year (on behalf of the City of Martteca) l c=j 16.International Shipments 1- ❑Imponto U.S. ❑Exporfrom U.S. Porto entrylexit Transporter signature(for exports only): Dater ving U.S.: w 17.Transporter Acknowledgment of Receipt of Materials Tran iter 1 Printed/ryped Name Signa Month Day Year H J `t7 ��JL VO1(�rJ QTransporter Pnn ed7Fyped Name Signature Month Day Year C f I 16.Discrepancy 18a.Discrepancy Indication Space El 1:1El Quantity Type Residue Partlal Rejection Full Rejection Manliest Reference Number 18b.Alternate Facility(or Generator) U.S.EPA ID Number J U LL Faolity's Phone. W 18c.Signature of Alternate Facility(or Generator) Month Day Year a z S2 19.Hazardous Waste Repod Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) 2. 3. 4. 1 20.Designated Facility Owner or Operator:Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a Printed/Typed NameI �� Signature Month OD IYea At�EPA Form 8700-22(Rev.3-05) Previous editions are obsolete. DESIGNATED FACT ITYT D STINATION STATE (IF REOUIR D)